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Abstract
Background: Cotton dust induced respiratory disorders are dramatically increased over the globe, especially the
problem is serious in developing countries. Respiratory symptoms, such as cough, phlegm, wheezing, shortness of
breath, chest tightness, chronic bronchitis, and byssinosis are common among workers exposed to cotton dust.
However, in Ethiopia, the magnitude of the problem is not well known and information is limited about the risk
factors. Therefore, this study was aimed to assess the prevalence of respiratory symptoms and associated factors.
Methods: A Comparative cross-sectional study design was employed. A total of 413 (276 exposed and 137 unexposed)
participants were included in the study. Stratified and simple random sampling techniques were used to select exposed
and unexposed groups to cotton dust respectively. Multivariable binary logistic regression analyses was performed to
identify variables associated with respiratory symptoms and adjusted odds ratio (AOR) was used to determine the
strength of associations. Significance level was obtained at 95% confidence interval (CI) and p-value ≤0.05.
Results: The prevalence of self-reported respiratory symptoms was 47.8% (95% CI: 41.3, 53.7%) and 15.3% (95% CI:
9.6, 22.3%) among exposed and control groups respectively. Sex (AOR = 2.1, 95% CI: 1.29, 3.45), service year (AOR
= 2.38, 95% CI: 1.19, 4.71) and ventilation (AOR = 2.4, 95% CI: 1.17, 4.91) were factors significantly associated with
respiratory symptoms. Furthermore, working department such as; ginning (AOR = 5.1, 95% CI: 2.13, 12.16), spinning
(AOR = 4.96, 95% CI: 2.18, 11.29), weaving (AOR = 5.9, 95% CI: 2.46, 14.27) and blowing working departments (AOR = 5.
14, 95% CI: 1.4, 18.94) were significantly associated with respiratory disorders.
Conclusions: The prevalence of self-reported respiratory symptoms was higher among workers exposed to cotton dust
than unexposed workers. Sex, service year, working department and work unit ventilation were predictor variables for
respiratory symptoms. Thus, reducing exposure to dust, adequate ventilation and improving the hygiene of working
departments are needed to reduce respiratory symptoms.
Keywords: Respiratory symptoms, Cotton dust, Textile factory workers, Northwest Ethiopia
* Correspondence: sintayehudaba2004@gmail.com
Department of Environmental and Occupational Health and Safety, Institute
of Public Health, University of Gondar, Gondar, Ethiopia
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
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Daba Wami et al. Journal of Occupational Medicine and Toxicology (2018) 13:13 Page 2 of 7
Background Methods
Occupational respiratory diseases are a major global Study design and study population
public health problem that account for up to 30% of A Comparative cross-sectional study design was employed
all registered work related diseases and 10–20% of in northwest Ethiopia textile factory.
deaths are caused by respiratory problems [1]. Owing The source population of this study was all workers in
to an exposure to occupational airborne particulates, northwest Ethiopia textile factories and those who were
an estimated 386, 000 deaths and nearly 6.6 million worked in ginning, spinning, weaving and blowing depart-
disability adjusted life years (DALYs) occurred among ments. Those workers who worked for more than 1 year
workers [2]. With respect to cotton dust exposure, were included in the study. However, workers with previ-
chest tightness was the most common respiratory ous exposure to other occupational dust such as silica,
symptom (20.3%). About 14.2% of cotton processing coal dust and who have history of smoking were excluded.
workers were encountering byssinosis [3]. Moreover, workers who had history of asthma or chronic
The ginning, spinning and weaving process of textile obstructive pulmonary disease (COPD) before joining to
industry generate large amount of cotton dust. The the work were also excluded from this study.
dust consists of different size and type of particles, such Regarding the activities carried out in working unit,
as ground-up plant matter, fiber, bacteria, fungi, soil, Ginning section involves the process of separating of the
pesticides, non-cotton matter, and other contaminants cotton fibers from the seed for the conversion of the cot-
[4, 5]. Exposure to the cotton dust led to respiratory ton into a continuous thread. Cotton ginning consists
problems, such as cough, phlegm, wheezing, shortness simple operations, which was done mechanically. During
of breath, chest tightness, chronic bronchitis, and bys- the ginning process, dust fibers and lint are generated
sinosis [6–8]. Exposure to cotton dust has also pro- which can be inhaled by workers.
found effect on pulmonary function [8]. Byssinosis is a Blowing section is the initial stage in spinning process.
chronic respiratory disease that is seen among workers Blow department is consisting of different machines in
exposed to cotton dust [9, 10]. The type and concentra- which the supplied compressed bales are opened, cleaned,
tion of dust, duration of exposure and genetic factors dust removed, mixing or blending performed for making
are interplaying the diseases of the respiratory system uniform lap of definite length. It is sued in succession to
induced by occupational dusts [11, 12]. Moreover, open and clean the cotton fiber according to the required
working in the department where there is higher expos- amount of degree.
ure of cotton dust such as spinning and weaving and The Spinning department uses machines in order to
being aged were found to be the risk factors for respira- produce cotton into threads of required size from the
tory problems related to cotton dust [10]. locks of cotton.
Respiratory problems related to coton dust start to The Weaving department comprises different activities
decline in developed countries as a result of stringent such as winding, warping, gluing and weaving. Then,
measures taken by the employers and workers. cloth is obtained from the chain threads placed vertically
However, the problems are quite neglected in develop- and the weft threads placed horizontally. Cloths are
ing countries [13, 14] and there is lack of health afterwards stocked in the warehouse.
information. The source population for unexposed group were both
Textile industry is one of the major manufacturing the general administration staff members of the textile
industry, which is established across the developed factories and external workers in the informal sectors
and developing countries including Africa [15]. In de- located in the surroundings (estimated to be 200–
veloping countries, notably in Africa, the cotton in- 500 meter far from technical department of textile fac-
dustry occupies an important place. The cotton sector tory) having at least 1 year of job activities. Those who
is expanding considering the size of cotton produc- have history of smoking, asthma or COPD were ex-
tion and the number of people employed in this sec- cluded from unexposed group.
tor [10]. In Ethiopia, textile industry or cotton sector
is the main economic motor that attracts numerous
work forces [16]. However, the workers are at risk of Sample size determination
cotton dust related respiratory problems. But the The sample size was determined using double popula-
degree of the problem is not well known and there is tion proportion formula using EpiInfo software consider-
a scarcity of data showing these kinds of health issues ing the following assumptions: proportion of respiratory
and its risk factors in Ethiopia. symptoms among exposed group (36.9%) [10], propor-
Therefore, this study was conducted to assess cot- tion of respiratory symptoms among unexposed group
ton dust exposure, self-reported respiratory symptoms (21.2%) [10], 95% confidence interval, 80% power, mar-
and associated factors among textile factory workers. gin of error (5%), 2:1 ratio of exposed to unexposed
Daba Wami et al. Journal of Occupational Medicine and Toxicology (2018) 13:13 Page 3 of 7
groups. A total of 413 study participants, 276 exposed Data processing and analysis
and 137 unexposed groups were included in this study. The data were checked, coded and entered in to epi-
demiological information package (EPi-info) version 7.
2.0.1 and exported to statistical package for social sci-
Sampling procedures ences (SPSS) version 20 for further analysis. For most
Study subjects from the exposed groups were selected variables, data were presented as frequencies and per-
using stratified sampling technique, assuming that centages. Univariate logistic regression analysis was
workers in different departments would exhibit different performed primarily to select variables for the final
level of exposure to cotton dust. Study subjects were al- model on the basis of p-value < 0.2. Multivariable binary
located to each stratum proportionally and selected by logistic regressions analysis was employed to control
simple random sampling. Whereas, the unexposed the possible effect of confounders and finally the vari-
groups were selected by simple random sampling tech- ables which had significant association were identified
nique using their salary payment roaster sheet, which on the basis of AOR with 95% CI and p-value ≤ 0.05.
was obtained from their respective offices.
Results
Demographic and socio-economic characteristics of the
Measurment of variables study participants
Respiratory symptoms, the primary outcome variable of Of the total 413 questionnaires (276 exposed and 137
the study was determined by the presence of one or unexposed) distributed, 401 (270 exposed and 131 un-
more respiratory symptoms such as, cough, phlegm, exposed) completed and valid questionnaires were ana-
wheezing, dyspnea, chest pain and breathlessness among lyzed, which gives a response rate of 97.1%.
workers. Two third, 169 (62.6%) of exposed and half, 66 (50.4%)
Ventilation condition, the ventilation condition of the of unexposed participants were males. The mean age (±
working units was reported as adequate if the working SD) of the respondents among exposed and unexposed
unit furnished with functional mechanical ventilation was 28.24 (± 7.58) and 29.79 years (± 7.4) respectively
system (ventilator, Local exhaust ventilation system) and (Table 1).
natural ventilation systems (doors, windows and any
other openings). Lack of obstruction of air flow in the Table 1 Demographic and socio-economic characteristics of
unit also considered and if the data collector senses suf- textile factory workers, northwest Ethiopia, 2017 (N = 413)
ficient air circulation in the working unit; fair if there is Variables Exposed Unexposed
frequency (%) frequency (%)
functional mechanical ventilation system and natural
Sex
systems, but obstructed air flow due to poor design of
the working units; and inadequate if the unit lacks func- Female 101 (37.4%) 65 (49.6%)
tional mechanical and natural ventilation system, and if Male 169 (62.6%) 66 (50.4%)
the air flow obstructed by adjacent buildings and poor Age(years)
layout of the unit. ≤ 29 199 (73.7%) 74 (56.5%)
30–39 43 (15.9%) 42 (32.1%)
≥ 40 28 (10.4%) 15 (11.5%)
Data collection procedures
Mean ± SD 28.24 ± 7.58 29.79 ± 7.4
The data were collected by using a modified question-
naire of medical research council (MRC) of Great Britain Marital status
and work place observation checklists. The question- Single 158 (58.5%) 54 (41.2%)
naire consisted of three parts, like socio-demographic, Married 109 (40.4%) 76 (58%)
environmental and behavioral factors, and respiratory Divorced/Widowed 3 (1.1%) 1 (0.8%)
symptoms. Face-to-face interview and observation of the Years of service in current industry (years)
working units were performed to collect data. Prior to
1–2 56 (20.7%) 14 (10.7%)
the data collection, training was given for data collectors
and supervisors for 3 days on procedures, techniques 2–5 118 (43.7%) 83 (63.4%)
and ways of collecting the data. Clear introduction ≥6 96 (35.6%) 34 (26.0%)
explaining the purpose and objective of the study was Monthly salary
provided to the respondents on the first page of the ≤ 1500 163 (60.4%) 37 (28.2%)
questionnaire before data collection. In addition con- 1501–2500 87 (32.2%) 46 (35.1%)
tinuous and strict supervision and on spot checking was
≥ 2501 20 (7.4%) 48 (36.6%)
carried out during the data collection process.
Daba Wami et al. Journal of Occupational Medicine and Toxicology (2018) 13:13 Page 4 of 7
Table 3 Multi variable analysis of factors associated with Factors Table 3 Multi variable analysis of factors associated with Factors
associated with respiratory symptoms among textile factory associated with respiratory symptoms among textile factory
workers, northwest Ethiopia, 2017 (N = 413) workers, northwest Ethiopia, 2017 (N = 413) (Continued)
Variables Respiratory COR AOR Variables Respiratory COR AOR
symptoms (95% CI) (95% CI) symptoms (95% CI) (95% CI)
No Yes No Yes
Sex Ventilation of the working unit
Female 123 43 1.00 1.00 Adequate 58 16 1.00 1.00
Male 129 106 2.35 2.1 Fair 127 70 1.99 2.1
(1.53, 3.62) (1.29, 3.45)* (1.07, 3.74) (1.07, 4.19)*
Age(years) Inadequate 67 63 3.41 2.4
(1.78, 6.54) (1.17, 4.91)*
≤ 29 170 103 1.00 1.00
PPE use
30–39 56 29 0.86 1.6
(0.51, 1.43) (0.81, 3.14) No 148 61 1.00 1.00
≥ 40 26 17 1.1 1.63 Yes 104 88 2.05 099
(0.56, 2.1) (0.67, 3.98) (1.36, 3.1) (0.59, 1.66)
Marital status Note: * =
P-value ≤0.05, ** = p-value ≤0.001
and various studies indicated that lack of ventilation in informed verbal consent from the manager and workers. The purpose of the
cotton industry working environment as a major factor study was explained and confidentiality of the information was assured.
Privacy was also ensured during the interview.
of developing respiratory symptoms among cotton in-
dustry workers [32]. Moreover, their effects have a ten- Consent for publication
dency to be more pronounced in the case of poor Privacy and confidentiality of information given by each respondent was
kept properly and personal identifiers were removed.
ventilation [33].
Lack of the Pulmonary Function Test and measure- Competing interests
ment of cotton dust concentration to strengthen the The authors declare that they have no competing interests.